Issue link: http://clhia.uberflip.com/i/406567
2 patients. Currently, specialty drugs represent about 20 per cent of plan costs for employers, but only one per cent of total claims. They are forecast to represent 25 to 35 per cent of cost by 2015. 2 Such drugs have a significant annual cost (some can be well over $50,000 per year) and are typically indicated for genetic enzyme disorders, cancer treatments, and auto-immune disorders. If the growing burden of high cost drugs, in particular, is not addressed there is a real risk that employers will take steps to restrict their drug coverage. In 2011, benefit payments for prescription drugs in Canada by our industry totaled $10.1 billion and private payers accounted for roughly 55 per cent of total drug purchases. Any significant reduction in coverage by employers would have dramatic implications, not only for individuals, but governments as well. Governments in Canada are increasingly looking to moderate the rate of growth of their health expenditures and, given their respective difficult fiscal situations, would be challenged to take on a significant proportion of the drug spend that is accounted for by private plans currently. In addition, the current patchwork of drug coverage results in inequities between Canadians. A drug that is covered for an individual in one province may not be covered for an individual in another province. As well, the price that is paid for the same drug will vary greatly across Canada depending on whether an individual is covered by a provincial plan, private insurance or is paying out-of-pocket. The system is also highly complex system and difficult to navigate. Most worryingly, it is clear that in some regions of the country, many Canadians do not have any, or only inadequate, drug coverage. These gaps in coverage can result in significant financial strain for these individuals. Any long-term solution to these challenges will require both public and private payers to make adjustments to their programs and to work more collaboratively going forward. The Canadian life and health insurance industry has a unique and important perspective on how the current system functions and therefore how to reform pharmacare for the benefit of Canadians. As 2 ESI 2011 Drug Trend Report.